K. Affeld

Flow-Induced Platelet Activation in Bileaflet and Monoleaflet Mechanical Heart Valves

A study was conducted to measure in vitro the procoagulant properties of platelets induced by flow through Carbomedics bileaflet and Bjork–Shiley monoleaflet mechanical heart valves (MHVs). Valves were mounted in a left ventricular assist device, and platelets were circulated through them under pulsatile flow. Platelet activation states (PAS) were measured during circulation using a modified prothrombinase method. Computational fluid dynamics (CFD) simulations of turbulent, transient, and non-Newtonian blood flow patterns generated by the two valve designs were done using the Wilcox k−ω turbulence model, and platelet shear-stress histories (the integral of shear-stress exposure with respect to time) through the two MHVs were calculated. PAS measurements indicated that the bileaflet MHV activated platelets at a rate more than twice that observed with the monoleaflet MHV. Turbulent flow patterns were evident in CFD simulations for both valves, and corroborated the PAS observations, showing that, for particles close to the leaflet(s), shear-stress exposure in the bileaflet MHV can be more than four times that in the monoleaflet valve.

Flow simulation studies in coronary arteries--impact of side-branches.

AIMS Wall shear stress (WSS) may induce local remodeling of the vascular wall and the WSS pattern in turn depends on vascular geometry. We aimed to elucidate the impact of side-branches on local WSS. METHODS AND RESULTS Steady numerical flow simulation studies were performed in three-dimensional reconstructed right coronary artery (RCA) trees. RCA from seven controls, five patients with coronary artery disease (CAD) and five patients with aneurysmatic CAD (AnCAD) classified by expert visual diagnosis were studied. Then three transient flow simulations were performed with cases representative for each group in order to evaluate the impact of pulsatile flow simulation. As vascular size and flow rates vary considerably between patients, non-dimensional approaches were applied for group comparison. A point-to-point comparison of the WSS in the same tree with and without side-branches revealed local differences in WSS of up to 12.0 Pa. This was caused by a reduction of volume flow of up to 78.7% in the trunk. Differences are not only limited to bifurcation sites but also affect local narrowings and strongly curved segments. The point-to-point comparison of steady and transient simulations found an average increase of WSS of below 7% in transient simulations. No significant differences were found between histograms of pulsatile and steady simulations, showing a high cross-correlation of >0.97. CONCLUSION Side-branches must not be neglected in numerical flow simulation (steady and transient) studies. Steady simulations are valid for an assessment of time-averaged WSS distributions.

Numerical Analysis of Blood Damage Potential of the HeartMate II and HeartWare HVAD Rotary Blood Pumps

Implantable left ventricular assist devices (LVADs) became the therapy of choice in treating end-stage heart failure. Although survival improved substantially and is similar in currently clinically implanted LVADs HeartMate II (HM II) and HeartWare HVAD, complications related to blood trauma are frequently observed. The aim of this study was to compare these two pumps regarding their potential blood trauma employing computational fluid dynamics. High-resolution structured grids were generated for the pumps. Newtonian flow was calculated, solving Reynolds-averaged Navier-Stokes equations with a sliding mesh approach and a k-ω shear stress transport turbulence model for the operating point of 4.5 L/min and 80 mm Hg. The pumps were compared in terms of volumes subjected to certain viscous shear stress thresholds, below which no trauma was assumed (von Willebrand factor cleavage: 9 Pa, platelet activation: 50 Pa, and hemolysis: 150 Pa), and associated residence times. Additionally, a hemolysis index was calculated based on a Eulerian transport approach. Twenty-two percent of larger volumes above 9 Pa were observed in the HVAD; above 50 Pa and 150 Pa the differences between the two pumps were marginal. Residence times were higher in the HVAD for all thresholds. The hemolysis index was almost equal for the HM II and HVAD. Besides the gap regions in both pumps, the inlet regions of the rotor and diffuser blades have a high hemolysis production in the HM II, whereas in the HVAD, the volute tongue is an additional site for hemolysis production. Thus, in this study, the comparison of the HM II and the HVAD using numerical methods indicated an overall similar tendency to blood trauma in both pumps. However, influences of turbulent shear stresses were not considered and effects of the pivot bearing in the HM II were not taken into account. Further in vitro investigations are required.

Novel non-dimensional approach to comparison of wall shear stress distributions in coronary arteries of different groups of patients

BACKGROUND Local wall shear stress (WSS) has an impact on local remodelling of the vessel wall. WSS in turn strongly depends on local geometry. Our aim was to characterize patterns of local wall shear stress associated with distinct types of remodelling in coronary arteries. Vessel size and flow rates are different between patients, however. To compare distribution patterns of WSS in analogy to fluid-dynamic modelling, non-dimensional WSS/area functions are calculated. METHODS Right coronary arteries from seven controls, five patients with coronary artery disease (CAD) and five patients with aneurysmatic CAD (AnCAD) were analyzed. Flow simulations were performed in three-dimensionally reconstructed coronary vessels from biplane angiographic projections. Local WSS was normalized as percentage of maximum value in a histogram (100 classes) and corresponding area was expressed as percentage of total area. RESULTS The normalized WSS distribution was characterized by a single peak with a large lower tie in controls, a loss of the single peak and a stochastic distribution in AnCAD and a narrowing of the lower tie in CAD. Correct classification of 16/17 coronary arteries was feasible by Fishers discriminant functions based on median WSS, mean diameter, percentage of area with WSS <or=0.4 Pa and with WSS >or=15 Pa. CONCLUSION Normalized WSS distribution might be an efficient tool in comparing wall shear stress between different patient groups. Whether normalized WSS distribution curves are apt to grade severity of disease remains to be investigated.

Measurement of the local velocity of the solid phase and the local solid hold-up in a three-phase flow by X-ray based particle tracking velocimetry (XPTV)

Abstract The measurement of the local solid velocity and the local solid hold-up in three-phase flows (gas, liquid, solid) is of great interest with regard to the design of three-phase reactors. Moreover, such measurements are necessary for the validation of flow simulations of three-phase flows. The optical methods usually applied for velocity measurements such as particle image velocimetry do not work in three-phase flows. This is due to the opacity of the solid phase or/and because of the reflections and refractions that occur on phase boundaries. Other measurement methods are intrusive and very time consuming. The measurement of the local solid hold-up is even more difficult. The new X-ray based particle tracking velocimetry (XPTV), described in this paper, measures the solid velocity and the solid content simultaneously. This fast working and non-intrusive technique has already been successfully applied in a bubble column to measure the liquid velocity. XPTV is a three-dimensional three-component method. It works independently from void fraction and solid hold-up.

Geometry of the human common carotid artery. A vessel cast study of 86 specimens

The carotid artery is of special interest for the pathologist because of its frequent depositions, and for the fluidmechanician because of its complex flow properties. However, there is a distinct lack in current knowledge of its geometry. Therefore, a vessel cast study was undertaken. At post mortem, the arteries are excised and filled with a special resin at the proper transmural pressure. Eighty-six vessel casts of the carotid artery were performed, and some etiological factors of atherosclerosis, such as age, sex and disease, were collected. The following selected geometric parameters of these vessel casts were measured in this study: the diameters of the main branches of carotid bifurcation (common, internal and external arteries), and the angles between internal, external and common carotid arteries. The averaged geometric parameters and their variability over 86 vessel casts of the carotid artery were investigated. Furthermore, the relationship between these measured parameters and the etiological factors age, sex and disease was analyzed. The geometric parameters varied considerably, presumably contributing to a corresponding variability in the local hemodynamic and distribution of the atherosclerotic lesions.

In vitro study of near-wall flow in a cerebral aneurysm model with and without coils.

BACKGROUND AND PURPOSE: Coil embolization procedures change the flow conditions in the cerebral aneurysm and, therefore, in the near-wall region. Knowledge of these flow changes may be helpful to optimize therapy. The goal of this study was to investigate the effect of the coil-packing attenuation on the near-wall flow and its variability due to differences in the coil structure. MATERIALS AND METHODS: An enlarged transparent model of an ACA aneurysm was fabricated on the basis of CT angiography. The near-wall flow was visualized by using a recently proposed technique called Wall-PIV. Coil-packing attenuation of 10%, 15%, and 20% were investigated and compared with an aneurysmal flow without coils. Then the flow variability due to the coil introduction was analyzed in 10 experiments by using a packing attenuation of 15%. RESULTS: A small packing attenuation of 10% already alters the near-wall flow significantly in a large part of the aneurysmal sac. These flow changes are characterized by a slow flow with short (interrupted) path lines. An increased packing attenuation expands the wall area exposed to the altered flow conditions. This area, however, depends on the coil position and/or on the 3D coil structure in the aneurysm. CONCLUSIONS: To our knowledge, this is the first time the near-wall flow changes caused by coils in an aneurysm model have been visualized. It can be concluded that future hydrodynamic studies of coil therapy should include an investigation of the coil structure in addition to the coil-packing attenuation.

Theoretical modeling of the interaction between alveoli during inflation and deflation in normal and diseased lungs

Alveolar recruitment is a central strategy in the ventilation of patients with acute lung injury and other lung diseases associated with alveolar collapse and atelectasis. However, biomechanical insights into the opening and collapse of individual alveoli are still limited. A better understanding of alveolar recruitment and the interaction between alveoli in intact and injured lungs is of crucial relevance for the evaluation of the potential efficacy of ventilation strategies. We simulated human alveolar biomechanics in normal and injured lungs. We used a basic simulation model for the biomechanical behavior of virtual single alveoli to compute parameterized pressure-volume curves. Based on these curves, we analyzed the interaction and stability in a system composed of two alveoli. We introduced different values for surface tension and tissue properties to simulate different forms of lung injury. The data obtained predict that alveoli with identical properties can coexist with both different volumes and with equal volumes depending on the pressure. Alveoli in injured lungs with increased surface tension will collapse at normal breathing pressures. However, recruitment maneuvers and positive endexpiratory pressure can stabilize those alveoli, but coexisting unaffected alveoli might be overdistended. In injured alveoli with reduced compliance collapse is less likely, alveoli are expected to remain open, but with a smaller volume. Expanding them to normal size would overdistend coexisting unaffected alveoli. The present simulation model yields novel insights into the interaction between alveoli and may thus increase our understanding of the prospects of recruitment maneuvers in different forms of lung injury.

Variability of the Geometry of the Human Common Carotid Artery. A Vessel Cast Study of 31 Specimens

The carotid artery is of special interest both for the pathologist because of its frequent depositions and for the fluid mechanic because of its complex flow properties. However, current knowledge of its geometry is insufficient. Therefore, a vessel cast study was undertaken and a method to fabricate vessel casts was developed. At post mortem the arteries are excised and filled with a resin at the proper transmural pressure. Thirty-one vessel casts of the carotid artery were performed and the following selected geometric parameters of these vessel casts were measured: the diameters of the main branches of carotid bifurcation (common, internal and external arteries) and the angles between internal, external and common carotid arteries. The geometric parameters vary considerably and may contribute to a corresponding variability in local hemodynamics.

Estimation of wall shear stress in bypass grafts with computational fluid dynamics method.

Coronary artery bypass graft (CABG) operation for coronary artery disease with different types of grafts has a large clinical application world wide. Immediately after this operation patients are usually relieved of their chest pain and have improved cardiac function. However, after a while, these bypass grafts may fail due to for example, neointimal hyperplasia or thrombosis. One of the causes for this bypass graft failure is assumed to be the blood flow with low wall shear stress. The aim of this research is to estimate the wall shear stress in a graft and thus to locate areas were wall shear stress is low. This was done with the help of a blood flow computer model. Postoperative biplane angiograms of the graft were recorded, and from these the three-dimensional geometry of the graft was reconstructed and imported into the computational fluid dynamics (CFD) program FLUENT. The stationary diastolic flow through the grafts was calculated, and the wall shear stress distribution was estimated. This procedure was carried out for one native vessel and two different types of bypass grafts. One bypass graft was a saphenous vein and the other one was a varicose saphenous vein encased in a fine, flexible metal mesh. The mesh was attached to give the graft a defined diameter. The computational results show that each graft has distinct areas of low wall shear stress. The graft with the metal mesh has an area of low wall shear stress (< 1 Pa, stationary flow), which is four times smaller than the respective areas in the other graft and in the native vessel. This is thought to be caused by the smaller and more uniform diameter of the metal mesh-reinforced graft.